Maternal smoking during pregnancy has diverse adverse effects on fetal outcome, including increased risk of spontaneous abortion, stillbirth, premature delivery, low birth weight, early neonatal mortality, sudden infant death syndrome, and poor pulmonary outcome (Cunningham et al. (1994) Am. J. Epidemiol. 139: 1139-1152; Gilliland et al. (2003) Am. J. Respir. Crit. Care Med 167: 917-924.; Hanrahan et al. (1992) Am. Rev. Respir. Dis. 145: 1129-1135; Higgins (2002) Curr Opin Obstet Gynecol 14: 145-151; Hofhuis et al. (2003) Arch. Dis. Child 88: 1086-1090.). Maternal smoking during pregnancy adversely affects fetal lung growth that may result in adverse long-term consequences such as increased occurrence of lower respiratory illnesses and altered pulmonary mechanics on pulmonary function testing (Chen et al. (1987) Pediatr. Pulmonol., 3: 51-58; Collins et al. (1985) Pediair. Res. 19: 408-412; Gilliland et al. (2003) Am. J. Respir. Crit. Care Med 167: 917-924; Hofhuis et al. (2003) Arch. Dis. Child, 88: 1086-1090; Maritz (1988) Biol. Neonate, 53: 163-170; Scott (2004) Tobacco Induced Diseases 2: 3-25; Walsh (1994) Hum. Biol., 66: 1059-1092). The mechanisms underlying the general effects of maternal smoking on fetal viability and growth are generally thought to be due to fetal hypoxia (Cnattingius and Nordstrom (1996) Acta Paediair. 85: 1400-1402). The mechanisms underlying pulmonary outcomes, however, appear to be more complex and are poorly understood Scott (2004) Tobacco Induced Diseases 2: 3-25). On the one hand, there is evidence of increased surfactant production at birth, possibly contributing to a decrease in the incidence of respiratory distress syndrome (Curet et al. (1983) Am. J. Obstet. Gynecol. 147: 446-450; Gluck and Kulovich (1973) Am J Obstet Gynecol. 115: 539-546; Lieberman et al. (1992) Obstet. Gynecol. 79: 564570; 39. Wuenschell et al. (1998) Am. J. Physiol. Lung Cell Mol. Physiol. 274: L165-L170). On the other hand, there is strong evidence for deleterious effects on pre- and postnatal lung growth and development following in utero exposure to maternal smoking (Chen et al. (1987) Pediatr Pulmonol 3: 51-58; Cnattingius and Nordstrom (1996) Acta Paediatr 85: 1400-1402; Collins et al. (1985) Pediatr. Res., 19: 408-412; Cunningham et al. (1994) Am J Epidemiol 139: 1139-1152; Gilliland et al. (2003) Am. J. Respir. Crit. Care Med., 167: 9.17-924; Hanrahan et al. (1992) Am. Rev. Respir. Dis., 145: 1129-1135; Higgins (2002) Curr. Opin. Obstet. Gynecol., 14: 145-151; Hofhuis et al. (2003) Arch Dis Child 88: 1086-1090; Maritz (1988) Biol Neonate 53: 163-170; Scott (2004) Tobacco Induced Diseases 2: 3-25; Sekhon et al. (1999) J Clin Invest 103: 637647; Sekhon et al. (2001) Am. J. Respir. Crit. Care Med., 164: 989-994; Walsh (1994) Hum. Biol., 66: 1059-1092). The mechanisms underlying these seemingly paradoxical effects remain largely unknown.
There is, consequently, currently no specific treatment for the deleterious effects of smoking on the lung. Such patients are typically treated with steroids and P blockers, which alleviate the symptoms caused by smoking, but do not address the actual etiology of the smoke-induced effects.